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Stress or Life events

«Claude (Claude Bernard) was right : the germ is nothing, the ground is everything !»
(Louis Pasteur, to his friend, Professor Renon, who watched over him short before he died, 1895)

In sleep medicine, the notion of stress is, in our opinion, too restrictive.

All the events of life possess a "somno-toxic" effect but their impact on sleep efficiency is often independent of their objective intensity.


"There’s nothing wrong with you, it is probably stress..."

"Yes, I know, you understand, that’s because I have some problems..."

All events of life possess their own « somno-toxic » effect but their impact on sleep efficiency is often independent of their objective intensity.

Stress ...

"Stress" is a set of reactions of the body in front of a new or threatening situation. These reactions have developed during evolution in a way that we can survive thoses changes or threats.

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D’après Hebb PO, in "A Textbook of Psychology", Philadelphie, Baunders, 1966.

Stress, far from being harmful in itself can thus be very useful and we can be sure that it allowed our ancestors to escape from many dangers.

Nowadays, stressing stimuli are rarely wild biests and consist much more often in social situations like an exam or a verbal threat from another person.

The human culture gets more sophisticated, but the emotive basic reactions stay the same. (The brain at Mc Gill, Canada (in French))

Stress or life event ?

The notion of life event is wider than that of stress because the ground counts more than the intensity of the agression in the appearance of fatigue and functional disorders in a chart that we call the «hypo-sleep syndrome».

The events of life are situations on which the individual has no grip and that he has to face with his own abilities of resistance.

If his abilities to resist are large, sleep is not (or little) affected in spite of the intensity of the constraints.

If the subject is fragile or already exhausted, less important life events can be the occasion of the appearance of functional disorders (decompensation of the adaptative mechanisms

We can roughly try to classify life events into four categories:

Non exhaustive list of the elements of the "worry box", or of the traumatic records often placed in the foreground to interprete functional disorders or insomnia.

  • Situations of loss :

    • death of a relative, divorce;
    • mourning, miscarriage, abortion;
    • physical (and/or sexual) agression;
    • handicap (amputation, hysterectomy, mammectomy...),
    • emotional shock (hostage taking, accident, burglary...);
    • grief (of love);
    • loss of work, home, identity papers, credit card, reverse of fortune;
  • Situations of exhaustion :

    • harassment, insecurity, armed conflict;
    • professional overwork (Burn out [1], Karoushi [2]);
    • unrealistic responsbilities;
    • pregnancy, childbirth, breastfeeding, children ...;
    • hormonal changes linked to menstruation.
  • Situations of expectation :

    • dispute, adjournment or stand-by in a procedure;
    • uncertain illness (cancer, HIV, multiple sclerosis...);
    • imprisonment, captivity;
    • examination results, competition, promotion;
    • delays in building (a home);
    • current important project (business creation).
  • Changing habits :

    • modifications in life surroundings (moving houses, travelling, jet lag, climate, season);
    • rythm of rest (night or shift work, nap...);
    • voluntary sleep deprivation (TV);
    • withdrawal of an addiction (tobacco, alcohol, drugs...);
    • life hygiene (stop of all sport... transportation time...);
    • big family gathering (family meal...);
    • recent illness;
    • restrictive diet ...

"Somnotoxicity":

  • "Somnotoxicity" is the ability of having a bad influence on the balance of sleep (and thus, on its efficiency).

    The "somnotoxic" power of a life event is not strictly correlated to the intensity of the "stress".

    Some life events are such traumas that it would be illusory not to suffer of them during the time necessary for healing the wounds (and as time passes by, the subject retrieves his/her energy).

    Other events can seem insignificant but are sometimes responsible for a brutal decompensation of the sleep regulation systems according to the principle of the drop of water that makes the vase overflow.

  • It is tempting to open the "worry box" to "explain" this or that symptom. But in our opinion this approach is counterproductive since one can still not act on his/her problems.

    The somnologic or even "somnicologic"" approach of their chronobiological impact can, on the counterpart, present a certain amount of clues meant to improve sleep efficiency.

    It appears positive to us to avoid to add up a health problem (True False sick persons or False True sick persons) on events that are already difficult and traumatic.

See the article ("Burnout and Karoushi")

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P.S. 
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Footnotes

[1The term of "burn out" refers to an "inner fire" (that would destroy everything without affecting the appearance until the sudden crash). It is, according to the American stress specialists, a chart that associates tiredness, reduction of performance, loss of confidence, irritability and demotivation, a chart that contrasts with a certain hyperactivity that masks the symptoms of decompensation.

In psychiatry, it is a sort of masked "pre-depressive" chart.
In "somnicology", (in our opinion, there should be established a parallel between that chart and that of chronic fatigue syndrome.

[2The word "Karoushi" is used by the Japanese doctors to describe "death caused by work". Death (of early cerebrovascular accident or suicide) occurs in a characteristic context of professional overwork and gives cause to a recognition as a professional illness.

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